Organization Active NPI

Creative Psychology, LTD.

  • Clinical Psychologist
  • Crystal Lake, IL
National Provider Identifier
1295758092
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CREATIVE PSYCHOLOGY, LTD.
Practice address
610 N. Route 31
Suite E
Crystal Lake, IL 60012-3715
Phone
(815) 444-8469
Fax
(815) 479-1709
NPI assigned
Jul 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Linda Bedsole
Title
Owner
Phone
(815) 444-8469

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X IL Primary

Addresses

Primary practice location

610 N. Route 31
Suite E
Crystal Lake, IL 60012-3715

Mailing address

610 N. Route 31
Suite E
Crystal Lake, IL 60012-3715
Phone (815) 444-8469

Other identifiers 1

IdentifierTypeStateIssuer
05632073OtherILBLUECROSS/BLUESHIELD

National Provider Directory

National Provider Directory

Locations

610 N State Route 31
Ste E
Crystal Lake, IL 60012
Phone (815) 444-8469

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295758092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 N. ROUTE 31",
            "address_2": "SUITE E",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123715",
            "telephone_number": "815-444-8469",
            "fax_number": "815-479-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N. ROUTE 31",
            "address_2": "SUITE E",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123715",
            "telephone_number": "815-444-8469",
            "fax_number": "815-479-1709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE PSYCHOLOGY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BEDSOLE",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-444-8469",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUESHIELD",
            "identifier": "05632073",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.